Perils of guide wire fracture - Unrecognized retained foreign body.

A case is presented of retained guide wire fragment after percutaneous stone removal with probable mechanism of breakage. Nephrostomy access was obtained using Seldinger technique and the wire passed through a stenotic ureter with difficulty. After removal of the stone, the wire fragmented on removal and the upper and lower fragments were removed from above and below, respectively.

The POLST paradigm and form:Facts and analysis.

This white paper, prepared by a working group of the Catholic Medical Association, provides a commentary on a new type of end-of-life document called a POLST form (Physician Orders for Life-Sustaining Treatment) as well as on its model (or "paradigm") for implementation across the United States. After an introductory section reviewing the origin, goals, and standard defenses of the POLST paradigm and form, the paper offers a critical analysis of POLST, including an analysis of the risks that POLST poses to sound clinical and ethical decision-making. The paper ends with several recommendations to help Catholic healthcare professionals and institutions better address the challenges of end-of-life care with alternatives to POLST.